[Sleep apnea and ocular diseases]

Sleep apnea presents as recurrent respiratory arrests or shallow breathing during sleep, resulting in decreased oxygen saturation and sleep disruption. Among its various types, obstructive sleep apnea is the most common. Over the past few decades, the prevalence of sleep apnea has been on the rise, drawing increasing attention, particularly with the growing obesity and aging population. Prolonged exposure to a hypoxic environment due to sleep apnea not only damages multiple systems throughout the body but may also pose a threat to vision. Examining the relationship between sleep apnea and ocular diseases, along with exploring its pathogenesis, has become a prominent research topic in recent years. This article provides a comprehensive review of the existing literature concerning the correlation between sleep apnea and ocular diseases such as glaucoma, optic nerve diseases, retinal and choroidal diseases, and anterior eye segment diseases. In clinical practice, prioritizing early screening and treatment for sleep apnea is crucial to prevent the worsening of associated ophthalmic conditions.

[Clinical analysis of corneal interface infection]

Objective: To analyze the clinical features of corneal interface infection. Methods: A retrospective case series study was conducted to explore the clinical features of interstitial corneal infection. The data of eight patients (eight eyes) who were diagnosed with interstitial corneal infection after undergoing corneal transplant or corneal refractive surgery and visited Beijing Tongren Eye Center from January to December 2018 were collected, including two male and six female patients aged between 18 and 55 years (median age, 27 years). The patients' general information, surgical type, onset time, and clinical manifestations were recorded. The lesions were examined by in vivo corneal laser confocal microscopy (IVCM), and microbial cultures and drug sensitivity tests were performed. Results: Among the 8 patients, 4 had undergone small-incision lenticule extraction (SMILE), 2 had undergone lamellar keratoplasty, and 2 had undergone endothelial keratoplasty. The onset of infection occurred between 2 and 30 days after surgery, with a mean of 9.8 days. Among the 3 patients who had undergone SMILE, the treatment outcome was corneal haze or opacity, while the remaining 5 cases required corneal transplantation for interstitial infections. The pathogens of the 4 cases of interstitial infection after corneal transplantation were all Candida species. Under the IVCM, patients with corneal interstitial bacterial infections showed a large amount of necrotic tissue with no normal tissue structure in the corneal stroma, with infiltration of inflammatory cells and local aggregation of inflammatory cells, but no typical pathogen was observed. Patients with fungal infections showed fungal hyphae under the corneal cap (filamentous fungal infection) or dense, punctate, high-reflection structures in the corneal interstitial space (yeast-like fungal infection). Conclusions: Corneal interlayer infection is difficult to diagnose early and has a poor prognosis. IVCM can assist in early diagnosis. The pathogen spectrum of corneal interlayer infection may differ from that of corneal infection caused by trauma.

[Clinical features and ocular manifestations of monkeypox virus infection]

Monkeypox is the most important orthopoxvirus infectious disease in humans after the extinction of smallpox. Recent outbreaks of monkeypox in several countries show obvious human-to-human transmission, which has aroused great concern around the world. Monkeypox infection can also affect the eyes. This article reviews the clinical features and ocular manifestations of monkeypox virus infection in order to attract the attention of ophthalmologists.

[Clinical manifestations of 1 015 cases of herpes simplex virus keratitis]

Objective: To explore the demographic distribution, clinical signs, and clinical types of herpes simplex virus keratitis (HSK). Methods: Retrospective case series. The data of 1 015 cases of HSK (1 054 eyes) diagnosed in Beijing Tongren Eye Center, Beijing Tongren Hospital of Capital Medical University from January 2010 to June 2019 were collected. The patients included 613 males and 402 females, and the age was 47.43±16.79 years. Information of the patients such as age, sex, the season of onset, eye laterality, and clinical signs was assessed. Slit-lamp microscopy and corneal fluorescein staining were used to locate the anatomical position of lesions. HSK was classified into epithelial type, neurotrophic type, stromal type, endothelial type, and mixed type. The distribution data was compared by the Chi-square test or Fisher's exact test. Results: There were 41 children (≤14 years old; 4.04%), 338 youth (15-44 years old; 33.30%), 374 middle-aged (45-59 years old; 36.85%), and 262 elderly (≥60 years old; 25.81%) patients. The type was epithelial in 246 cases (24.24%), neurotrophic in 27 cases (2.66%), stromal in 372 cases (36.65%), endothelial in 274 cases (26.99%), and mixed in 96 cases (9.46%). There was statistically significant difference in clinical typing among the different age groups (χ²=30.197, P=0.003). Epithelial HSK was found in 141 males (57.32%) and 105 females (42.68%), neurotrophic HSK in 16 males (59.26%) and 11 females (40.74%), stromal HSK in 226 males (60.75%) and 146 females (39.25%), endothelial HSK in 171 males (62.41%) and 103 females (37.59%), and mixed HSK in 59 males (61.46%) and 37 females (38.54%). There was no statistically significant difference in clinical classification of keratitis between genders (χ²=1.519, P=0.823). Among the cases of mixed type, there were 21 cases of epithelial-stromal type (21.88%), 30 cases of epithelial-endothelial type (31.25%), 37 cases of stromal-endothelial type (38.54%), 1 case of epithelial-neurotrophic type (1.04%), and 7 cases of neurotrophic-stromal type (7.29%). Conclusions: HSK occurs mainly in middle-aged and young adults, but rarely in children. The proportion of males is higher than that of females. The proportion of stromal HSK is highest, and 9.46% of patients present mixed HSK.

[Etiological analysis of infectious keratitis in children from 2007 to 2016]

Objective: To analyze the etiological changes of children with infectious keratitis. Methods: Retrospective study. Data of patients diagnosed as bacterial, fungal, and amoebic keratitis from 2007 to 2016, aged no more than 14 years old, were collected in the Department of Ophthalmology, Beijing Tongren Hospital. A total of 649 samples were obtained for routine laboratory culture identification and drug sensitivity tests. There were 361 males and 278 females, aged (5.6±4.4) years. The data were analyzed according to age ≤3 years, 4 to 7 years and>7 years. The qualitative data were analyzed by the Chi-square test. Results: Among 649 samples, 140 were culture positive, and the positive rate was 21.6%. Bacteria were the main pathogens, accounting for 81.4%. The positive rate was 31.0% among bacterial samples (114/368), and the bacterial flora was mainly Gram-positive cocci, followed by Gram-negative bacilli. Streptococcus (34.2%) ranked first, followed by Staphylococcus (27.2%) and Pseudomonas (7.9%). For children no more than 7 years old, Streptococcus pneumoniae was the most common bacterial species, while Staphylococcus epidermidis was most common in those aged 8-14 years. Gram-positive cocci were sensitive to vancomycin. Most bacteria were more sensitive to fluoroquinolones and less sensitive to cephalosporins and aminoguanidine. The detection rate of methicillin-resistant Staphylococcus was 68% (17/25). Gatifloxacin had the highest sensitivity, while the difference between gatifloxacin and moxifloxacin, levofloxacin, ofloxacin were not statistically significant (χ²=0.836,0.358, 1.490; P=0.361,0.550,0.222). A total of 254 specimens were cultured for fungi, of which 22 were positive, and the positive rate was 8.7%. The isolated fungi included Fusarium (34.8%, 8/22), Aspergillus (26.1%, 6/22) and Candida (13.0%, 3/22). The positive rate of fungal culture was 9.2% (11/119) from 2007 to 2011, and 8.1% (11/135) from 2012 to 2016, no significant difference was found between two period (χ²=0.096, P=0.757). Fusarium showed a relatively high sensitivity to terbinafine, but it was not sensitive to fluconazole and itraconazole. The sensitivities of Aspergillus to terbinafine and voriconazole were high, followed by amphotericin. Candida had high sensitivities to amphotericin, fluconazole, itraconazole and voriconazole. In 27 specimens for Acanthamoeba culture, 4 specimens were positive, and the positive rate was 14.8%. Risk factors of Acanthamoeba infection included wearing orthokeratology lenses and trauma. Conclusions: Bacteria are the main pathogenic agent of infectious keratitis in children. Streptococcus pneumoniae is the most common in children aged 7 and below, and Staphylococcus epidermidis is the most common in children aged 8-14. Fungal infection was significantly lower than that of bacteria, mainly Fusarium, Aspergillus and Candida.

[Efficacy of a recombinant bovine basic fibroblast growth factor gel for the treatment of moderate dry eye: a multicenter randomized double-blind parallel controlled clinical trial]

Objective: To compare the clinical efficacy of a recombinant bovine basic fibroblast growth factor (rb-bFGF) gel and a gel matrix in the treatment of moderate dry eye. Methods: It was a prospective random double-blind controlled study. One hundred patients diagnosed as moderate dry eye in Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Beijing Tongren Hospital, Capital Medical University, Eye & ENT Hospital of Fudan University and Zhongshan Ophthalmic Center from August 2015 to April 2019 were divided into two groups: experimental group and control group. Two groups of patients were allocated to receive either a rb-bFGF gel or a gel matrix 4 times per day for 4 weeks. Subjective symptoms, break-up time of the tear film (BUT), Schirmer Ⅰ test (SⅠt) and corneal fluorescein sodium staining were assessed at baseline, 2 and 4 weeks after treatment. Bulbar impression cytology was evaluated at baseline and 4 weeks after treatment. Irritation of the rb-bFGF gel and the gel matrix was estimated after treatment. T test, Wilcoxon signed-rank test or Mann-Whitney U test was used for quantitative data, and Chi-square test was used for enumerative data. Results: Eighty-four subjects were included for statistical analyses after the exclusion of 16 subjects who were lost for followup, with an age of 43±14 years. There were 42 cases in the experimental group and the control group, respectively. There was no statistically significant difference between the two groups in demographic baseline characteristics before treatment (P>0.05). The total score of subjective symptoms was 7.17±3.60 and 5.95±3.25 at 2 and 4 weeks after therapy in the experimental group, which were lower than 9.48±3.88 before treatment (t=6.226, 6.563; both P<0.05); in the control group, it was 7.01±3.25 and 6.32±3.85 at 2 and 4 weeks after treatment, with a significant reduction in comparison with that before treatment (9.15±3.58; t=4.693, 4.726; both P<0.05). The median (lower quartile, upper quartile) BUT was 4.00 (2.40, 5.00) s and 4.64 (3.00, 5.00) s at 2 and 4 weeks after therapy in the experimental group, which were longer than 3.72 (2.00, 4.39) s before treatment (Z=-2.485, -3.152; both P<0.05). The BUT was 4.41 (2.79, 5.12) s at 2 weeks after therapy in the control group, which was of no statistical difference compared with 3.89 (2.09, 4.25) s before treatment (Z=-1.953, P>0.05). The BUT was 5.21 (3.00, 5.02) s at 4 weeks after therapy in the control group, which was longer than that before treatment (Z=-2.485, P<0.05). The SⅠt score was 7.31 (3.75, 10.00) mm and 8.50 (4.00, 11.00) mm at 2 and 4 weeks after therapy in the experimental group, which were significantly higher than 6.69 (2.00, 8.13) mm before treatment (Z=-2.031, -2.236; both P<0.05); in the control group, it was 6.82 (2.00, 8.25) mm and 6.86 (3.00, 9.25) mm at 2 and 4 weeks after therapy, which were not significantly increased compared with 6.50 (2.00, 7.75) mm before treatment (Z=-0.179, -1.161; both P>0.05). The corneal fluorescein sodium staining points were 5.00 (2.00, 5.00) and 3.71 (0.00, 5.00) at 2 and 4 weeks after therapy in the experimental group, which were significantly lower than 7.10 (5.00, 7.00) before treatment (t=-2.895, -4.639; both P<0.05); those in the control group were 5.52 (0.00, 7.00) and 6.19 (0.75, 6.25) at 2 and 4 weeks after treatment, with a significant reduction in comparison with 8.90 (5.00, 10.50) before treatment (t=-2.776, -1.991; both P<0.05). The differences in the average total score of subjective symptoms, BUT, SIt, and corneal fluorescein sodium staining points between both groups were not statistically significant at each time point. The impression cytology grade was decreased from 1.72 (1.00, 2.00) before treatment to 0.94 (0.00, 2.00) at 4 weeks after therapy in the experimental group (Z=-2.803, P<0.05). The staining grade of conjunctival imprinted cells in the control group was 1.42 (1.00, 2.00) at 4 weeks, which showed no statistical significance compared with 1.56 (1.00, 2.00) before treatment (Z=1.195, P>0.05). The impression cytology grade was significantly reduced in the experimental group compared with the control group at 4 weeks after treatment (Z=-3.308, P<0.05). The number of goblet cells was 10.90 (5.00, 20.00) at 4 weeks after therapy in the experimental group, which was significantly higher than 6.30 (5.00, 8.00) before treatment (Z=-2.383, P<0.05); in the control group, it was 8.36 (4.00, 12.00) at 4 weeks after treatment, with no significant increase in comparison with that before treatment [7.55 (5.00, 11.00)] (Z=-0.095, P>0.05). The number of goblet cells was not significantly increased in the experimental group compared with the control group at 4 weeks after treatment (Z=-1.162, P>0.05). Most patients indicated that the drug was non-irritating, and no patient had intolerable irritation affecting daily lives at 4 weeks after therapy; there was no difference between the two groups (Z=-0.290, P>0.05). Conclusions: Both the rb-bFGF gel and the gel matrix can effectively improve the symptoms and signs of moderate dry eye. However, compared with the gel matrix, the rb-bFGF gel shows obvious advantages in promoting conjunctival epithelial cell repair and increasing the number of goblet cells. (Chin J Ophthalmol, 2021, 57: 930-938).

Early and mid-term outcomes of modified aortic root repair for acute stanford type A aortic dissection

Background

Acute Stanford type A aortic dissection (ATAAD) is the most common catastrophic aortic event. Most ATAAD involves the aortic root which has many important anatomical structures such as aortic valve, so the proper treatment of dissected root can ensure a good prognosis for patients. However, there is still no consensus on root management strategies for ATAAD patients with aortic root involvement.

Purpose

This clinical study aimed to evaluate the therapeutic effect of modified aortic root repair in ATAAD.

Methods

From September 2017 to September 2020, Participants with root involvement of ATAAD were recruited who underwent modified aortic root repair as well as some additional procedure such as aortic valve junction suspension plasty based on the aortic sinus tear extent. During this novel procedure, the proximal anastomosis plane was at the level of the sinu-tubular junction and the false lumen below it was retained. We collected and analyzed the perioperative clinical data and follow-up imaging data of patients, and further evaluated the early and mid-term efficacy of this surgical approach.

Results

A total of 79 patients were enrolled, including 59 males and 20 females, the age was (52.4±11.3) years old (28–73 years), the diameter of aortic sinus was (38.6±4.1) mm, and the diameter of sinu-tubular junction was (41.8±4.8) mm. In this group, 75 patients (94.9%) received ascending aorta replacement, total arch replacement and frozen elephant trunk, 2 patients (2.5%) received ascending aorta replacement and hybrid total arch replacement, 2 patients (2.5%) received ascending aorta replacement and partial arch replacement. Cardiopulmonary bypass time was (197.2±58.6) min (118–455 min), blocking time was (132.6±38.9) min (73–323 min), circulatory arrest time was (10.3±7.0) min (0–27 min). There was no perioperative death, no paraplegia, one secondary thoracotomy, five renal failures needing hemodialysis treatment and two cerebral infarctions. Before patients discharged, aortic CTA showed that the residual false lumen in the sinus disappeared. And the diameter of the aortic sinus was (35.5±3.1) mm, the diameter of the junction of the aortic sinus was (30.0±3.0) mm. The patients were followed up for (18±12) months (3–35 months). There was one patient died during follow-up and no further surgical intervention at the root of the aorta. Follow-up aortic CTA showed no residual or new dissection in the aortic sinus and no significant difference in the diameters of aortic sinu-tubular junction (P=0.122) or aortic sinus (P=0.37) between postoperative period and follow-up period. Echocardiography showed that the structure and function of the aortic valve were normal.

Conclusions

The modified aortic root repair for ATAAD is relatively simple, easy to learn and safe in perioperative period. Early and mid-term follow-up image examination showed that the structure of aortic sinus returned to normal. The long-term clinical effect requires close attention.

Funding Acknowledgement

Type of funding sources: None. Modified aortic root repair procedureAortic root diameter change under CTA

[Epidemiological characteristics of close contacts of COVID-19 cases and infection-related risk factors in Beijing]

Objective: To analyze the epidemiological characteristics of close contacts of COVID-19 cases and infection-related risk factors in Beijing and provide evidences for COVID-19 prevention and control. Methods: A total of 20 681 close contacts of COVID-19 cases, who had exposures during January 6, 2020 to February 15, 2021, were traced in Beijing. The information about their demographic characteristics, exposure history, and quarantine outcomes were collected and analyzed with descriptive statistics. The logistic regression analysis was used to identify the risk factors for COVID-19. Results: The infection rate SARS-CoV-2 in close contacts was 2.16% (447/20 681). The age M(P₂₅, P₇₅) was 35 (27, 49) years. The majority of the close contacts were aged 20-59 years, accounting for 81.77% (16 912/20 681). Centralized isolation was the major type of medical observation, accounting for 82.15% (16 989/20 681). Among the exposure types, working and studying in the same room (16.06%, 3 322/20 681), sharing same transport vehicle (12.88%, 2 664/20 681), performing diagnosis and treatment nursing (7.80%,1 612/20 681), and living together (7.23%,1 495/20 681), accounting for 43.96% (9 093/20 681). The index cases included staff (19.34%, 3 999/20 681), the unemployed (17.34%, 3 586/20 681), people engaged in business service (13.85%, 2 864/20 681), people engaged in food service (10.77%, 2 228/20 681), their close contacts accounted for 61.30% (12 677/20 681). Multivariate logistic regression analysis showed that compared with other types of exposure, the risk factors for infection were having meal together (OR=3.96, 95%CI: 2.30-6.83) and living together (OR=6.41, 95%CI:4.48-9.17); Compared with the other occupations, the index case being engaged in food service (OR=3.06, 95%CI:1.29-7.25) and teacher (OR=4.94, 95%CI:1.43-17.08) were risk factors for the infection. Conclusions: The main environmental exposure types of SARS-CoV-2 infection in close contacts were having meal together and living together. Contact with the index case being engaged in food service and teacher increased the risk for COVID-19. Comprehensive prevention and control measures such as centralized isolation and vaccination should be continued.

[Early outcome of valve sparing aortic root replacement with partial upper sternotomy]

Objective: To examine the early outcome of valve sparing aortic root replacement with reimplantation technique (David procedure) with partial upper sternotomy. Methods: From April 2016 to April 2020, 31 patients underwent valve sparing aortic root replacement under partial upper sternotomy at Vascular Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. There were 28 males and 3 females, aging (44±13) years (range: 11 to 65 years). Preoperative aortic regurgitation was found greater than moderate in 15 patients, moderate in 6 patients and less than moderate in 10 patients. The diameter of aortic annulus was (26±3) mm (range: 21 to 34 mm), the diameter of aortic sinus was (51±6) mm (range: 41 to 68 mm), the diameter of ascending aorta was (43±8) mm (range: 26 to 62 mm). The preoperative ejection fraction was (65±4) % (range: 59% to 72%) and left ventricular end-diastolic diameter was (55±6) mm (range: 42 to 68 mm). All cases were treated with David Ⅰ procedure, including simple David procedure in 26 patients, David+ascending aorta and partial aortic arch replacement in 3 patients, David+thoracic endovascular aortic repair in 1 patient, David+stent elephant trunk implantation in 1 patient. Results: The operation time, cardiopulmonary bypass time and aortic cross-clamping time were (330±58) minutes (range: 214 to 481 minutes), (138±23) minutes (range: 106 to 192 minutes) and (108±17) minutes (range: 82 to 154 minutes), respectively. There were no death and serious complications (stroke, myocardial infarction, renal insufficiency, severe infection, etc.). The postoperative drainage volume within 24 hours was (314±145) ml (range: 130 to 830 ml). The intubation time was (14±3) hours (range: 8 to 21 hours), and the ICU time was (M(Q_R)) 2.1(1.5) days (range: 1.0 to 5.0 days). Eight patients had no blood transfusion, the proportion of red blood cell use was 9.7% (3/31), plasma use was 22.6% (7/31), and platelet use was 71.0% (22/31). The postoperative left ventricular ejection fraction was (62±4)% (range: 54% to 69%), and left ventricular end-diastolic diameter was (48±4) mm (range: 39 to 56 mm). After operation, aortic regurgitation was significantly improved, with no more than moderate regurgitation, small to moderate regurgitation in 3 patients, minor regurgitation in 3 patients, micro regurgitation in 12 patients and no regurgitation in 13 patients. The follow-up period was 3.5(6.1) months (range: 2.0 to 39.0 months). Echocardiographic follow-up data were obtained in 26 cases, including moderate regurgitation in 1 patient, small to moderate regurgitation in 9 patients, minor regurgitation in 5 patients, micro regurgitation in 6 patients and no regurgitation in 5 patients. There were no major adverse cardiovascular events and aortic events during the follow-up period. No patient was reoperated for aortic regurgitation. Conclusion: Valve sparing aortic root replacement under partial upper sternotomy is safe and feasible, and the early result is satisfactory.

[Munchausen syndrome in a child]

A six-and-a-half-year-old girl with white secretions in her eyes for 2 weeks was treated in the Ophthalmology Department of the First Affiliated Hospital of Xi'an Jiaotong University after ineffective treatment in several hospitals. The patient refused to communicate with the doctor and receive detailed examination. Only conjunctival congestion was found in both eyes. According to the photos and specimens of white secretions from both eyes provided by the parents of the patient, the diagnosis was conjunctivitis and conjunctival foreign bodies. With the doctor's reminding, the parents did close observation and good communication. The child finally admitted that she had put tissue fragments into her eyes in order to attract the parents' attention. Munchausen syndrome was diagnosed by a psychiatrist. After symptomatic treatment and improvement of family environment, the patient's condition improved. (Chin J Ophthalmol, 2021, 57: 621-623).

Dynamics of Emim+ in [Emim][TFSI]/LiTFSI Solutions as Bulk and under Confinement in a Quasi-liquid Solid Electrolyte

Quasi-liquid solid electrolytes are a promising alternative for next-generation Li batteries. These systems combine the safety of solid electrolytes with the desired properties of liquids and are typically formed by solutions of Li salts in ionic liquids incorporated into solid matrices. Here, we present a fundamental understanding of the transport properties in solutions of lithium bis(trifluoromethanesulfonyl)imide (LiTFSI) in 1-ethyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide ([Emim][TFSI]), either in bulk form or incorporated in a boron nitride (BN) matrix. We performed a series of quasi-elastic neutron scattering experiments that, given the high incoherent neutron scattering cross section of hydrogen, allowed us to focus on the Emim⁺ dynamics. First, [Emim][TFSI]/LiTFSI solutions (0.5 and 2.5 mol·kg^-1) were investigated and we show how the increase in the concentration reduces the Emim⁺ mobility and increases the activation energy of their long-range motions. Then, the 0.5 mol·kg^-1 solution was incorporated into the BN matrix and we report that the diffusivities of the Emim⁺ cations that remain mobile under confinement are highly accelerated in comparison with the bulk sample and the activation energy of these motions is drastically reduced. We present the experimental evidence that this effect is related to the content of the Emim⁺ cations immobilized near the surfaces of the BN pores.

[A case of hand, foot and mouth disease in adults who first diagnosed with conjunctivitis]

A 34-year-old female presented to the doctor with chief complaint of redness in both eyes for 1 week. The slit lamp examination showed slight eyelid swelling, water-like discharge in the conjunctival sac of the lower eyelid, conjunctival follicles, gray-white pseudomembrane and small lamellar subconjunctival hemorrhage on the lower palpebral conjunctiva. Physical examination showed two erythematous macules(size 5 mm×6 mm) on the left palm. One erythematous macule(size 4 mm×5 mm) was seen on the right palm. Multiple erosions were located in the skin of upper and lower lips, oral cavity and the gingival mucosa. A diagnosis of hand, foot and mouth disease was made following by dermatological consultation. After topical antiviral and steroids treatment, the disease quickly relieved.(Chin J Ophthalmol, 2021, 57: 139-141).

[A clinical analysis of 46 cases of neurotrophic keratitis]

Objective: To investigate the clinical characteristics and therapeutic effect of neurotrophic keratitis (NK). Methods: A retrospective case series study. A total of 46 patients (48 eyes) with clinically diagnosed NK in Beijing Tongren Hospital from May 2013 to July 2016 were analyzed, including 26 males (26 eyes) and 20 females (22 eyes), aged (51±18) years. The general condition, etiology, clinical features, stage of disease and curative effect of NK patients were summarized. Corneal sensation was measured by Cochet-Bonnet corneal sensor for 25 patients (26 eyes), and the correlation between corneal sensation and clinical staging was analyzed. The χ(2) test was performed on the distribution characteristics of patients with different clinical stages of NK. Correlation analysis of corneal sensation and the disease stage was performed using Spearman correlation analysis. Results: Forty-four cases of monocular disease (96.65%) and 2 cases (4.35%) of bilateral disease were enrolled. Four eyes (8.33%) were from young patients (aged 18-29 years), 23 (47.92%) were from middle-aged patients (aged 30-59 years), and 21 (43.75%) were from elderly patients (aged ≥60 years). The disease was at stage Ⅰ in 8 eyes (16.67%), at stage Ⅱ in 21 eyes (43.75%), and stage Ⅲ in 19 eyes (39.58%). There was no significant difference in clinical staging between the three age groups (χ(2)=2.452, P=0.658). The most common cause of NK was virus infection (17 eyes,35.42%), followed by neurosurgical sequelae (11 eyes, 22.92%) and diabetes in 10 eyes(20.83%). Corneal sensation of 26 eyes ranged from 0-3 cm. There was no significant correlation between clinical stage and corneal sensation (r(2)=0.284, P=0.753). The patients were followed up for an average of 7 months. Thirty-four eyes (70.83%) received conservative treatment, and 8 eyes(16.67%) had surgery. Six patients (6 eyes) were lost for follow-up. Conclusions: NK can occur in all ages, mainly in the elderly. The clinical manifestations are diverse. If time delays in the diagnosis and treatment, it often causes corneal ulcers. There is no significant correlation between corneal sensation and clinical stage. Early diagnosis and targeted treatment are important for protecting patients' visual function.(Chin J Ophthalmol, 2020, 56:274-298).

[Analysis of HIV testing status and relevant factors in male sexually transmitted diseases patients in Shandong Province]

A survey was conducted to analyze the HIV testing status and related influencing factors of male sexually transmitted diseases(STD) patients attending 18 county-level hospitals in Shandong Province from July 2015 to August 2016. The HIV detection rate of 1 570 subjects was 77.58% (1 218/1 570), and the HIV-antibody positive rate was 0.99% (12/1 218). Compared with general hospitals patients, urinary and anorectal patients, non-sexual patients, and patients with negative attitudes toward HIV testing, patients were more likely to be tested for HIV from specialized hospitals (OR=3.74, 95%CI:2.53-5.54), the skin and venereal section (OR=1.92, 95%CI: 1.31-2.79), the STD group (OR=2.02, 95%CI: 1.34-3.03) and patients with positive attitude (OR=15.20, 95%CI:10.74-21.52).

Short-term acceptability of female condom use among low-fee female sex workers in China: a follow-up study

BACKGROUND

Low-fee female sex workers (FSW) lack power to effectively negotiate male condom use with clients. Female condoms (FCs) may provide an alternative strategy. This study was conducted to assess the acceptability of FC use among low-fee FSWs, and to identify appropriate candidates for future FC promotion.

METHODS

A one-month follow-up study was conducted. At entry into the study, eligible participants completed a baseline questionnaire and were given 10 FCs. At the one-month follow up encounter, the number of used FC packages were counted and each participant completed a follow-up questionnaire. Logistic regression was used to identify variables associated with more frequent use of FCs (> 2 times).

RESULTS

A total of 312 low-fee FSWs were enrolled at baseline and all participants completed the follow-up evaluation. Among them, 123 (39.4%) participants had used more than two FCs. Participants who were illiterate or had completed at most primary school education (OR: 2.4, 95% CI: 1.4-7.2), charged ≤30 RMB per client (≤30 vs. 51-80 RMB, OR: 3.8, 95% CI: 1.9-7.6), or had consistently used condoms with regular clients in the past month (OR: 2.4, 95%CI: 1.4-4.2) were more likely to use FCs.

CONCLUSION

Low-fee FSWs charging ≤30 RMB per client, and those who are less educated may be appropriate initial candidates for FC promotion in China. Strategies to consider include teaching FSWs tactics for negotiation of FC use that can initially be applied with regular clients, and providing education to maximize ease-of use, and minimize discomfort with FC usage.

[Related factors on secondary drug resistance in HIV infected persons receiving antiretroviral therapy in Shandong province: a case-control study]

Objective: To explore the causes of secondary drug resistance among HIV infected persons who were receiving antiretroviral therapy in Shandong province, and provide evidence for the improvement of antiretroviral therapy strategy. Methods: A case-control study was designed with 1∶2 matching on case and control groups. Household and face-to-face interview were conducted in October, 2015. All the study subjects were screened from both the drug resistant database of antiretroviral therapy of Shandong provincial laboratory and national comprehensive HIV/AIDS database in Shandong. The sample size was estimated as 330 cases including 110 drug resistant and 220 non-drug resistant cases. Subjects were people living with HIV/AIDS (PLWHA) aged 15 or older and received antiretroviral therapy for more than 6 months with records of virus load (VL). Subjects who presented VL above 1 000 copies/ml would receive drug resistance testing. Subjects who were confirmed resistant to with secondary drug, were selected as case group, the rest subjects with non-secondary drug resistance would form the control group. EpiData 3.1 software and SPSS 22.0 software were used to establish a database. Related influencing factors were analyzed with non- conditional stepwise logistic regression model. Results: A total of 288 cases were enrolled, including 103 in the case and 185 cases in the control groups, with average age as (37.62±1.06) years and (37.90±0.74) years old, respectively. Most of them were male, married/cohabitant, with education level of junior/senior high school or below and under Han nationality. Results from the multivariate logistic regression model showed that ORs (95%CI) of receiving antiretroviral therapy for 1-3 years, or more than 3 years were equal to 8.80 (3.69-21.00), 3.00 (1.20-7.53), compared with receiving antiretroviral therapy less than one year, respectively. OR (95%CI) of Among the PLWHA that with missing rate above 25.0% on medication, the OR appeared as 15.41(4.59-51.71), compared with not missing medication. OR (95%CI) among those who took the medicine themselves was 0.22 (0.07-0.74). Conclusions: Factors as duration of treatment, missing rate on medication and taking medicine by oneself were of influence on secondary drug resistance. Other factors as duration on antiretroviral therapy longer than 1 year, missing rate above 25.0% on medication, were related to the risk on secondary drug resistance. However, if the medicine was taken by oneself, it served as a protective factor for secondary drug resistance. It is necessary to strengthen the intervention and health education programs related to antiretroviral therapy.

[Analysis of etiology and in vitro drug susceptibility of fungal keratitis in northern China]

Objective: To analyze the etiology, drug susceptibility and etiological changes of fungal keratitis so as to to provide reference for clinical diagnosis and treatment. Methods: Retrospective case series study. A total of 5 654 copies of specimens for fungal culture were collected from Outpatients suspected of fungal keratitis in Beijing Tongren Ophthalmic Center during January 2007 and December 2016. Specimens were inoculated on Potato dextrose agar (PDA) slant medium, incubated at 30℃ and 40% humidity constantly for 3 to 10 days. Filamentous fungi isolated from positive cultures were identified according to morphological traits. Yeast-like fungi were identified by API 20 C Aux. Drug susceptibility tests were performed by using ROSCO disk diffusion method, which included natamycin, terbinafine, itraconazole, fluconazole, amphotericin B, voriconazole. The Chi-square test and Spearman correlation analysis were performed using SPSS 20.0 software. Results: The positive rate of culture was 26.1%. In positive patients, the ratio of male to female was 1.77∶1, and the age range was 11 days to 95 years. The mean age was 49.0±16.9 years. Among isolated fungi, Fusarium sp. was the most common genus, accounting for 53.5% (789 strains) , followed by 17.5% of Aspergillus sp. (259 stains) and 13.8% of Alternaria sp. (203 stains). The sensitive rate of natamycin was 92.3% (410 strains) , followed by that of terbinafine as 78.5% (1 093 strains), voriconazole as 41.0% (338 strains), amphotericin B as 40.7% (553 strains). Conclusion: The predominant patients of fungal keratitis are adult and male. Fusarium sp., Aspergillus sp., and Alternaria sp. are three common species in northern china with seasonal changes in their proportion. Natamycin should be the preferred drug for empirical treatment. The preferred empirical treatment for Aspergillus sp. is terbinafine. Fluconazole should not be used alone due to the high resistant rate. (Chin J Ophthalmol, 2018, 54: 432-436).

[Etiological and drug sensitivity analysis of lacrimal canaliculitis]

Objective: To analyze the etiology and drug sensitivity of lacrimal canaliculitis. Methods: Retrospective study of case series. The general information, culture results and drug sensitivity results of 52 patients (including 10 males and 42 females with an average age of 60.3 years) clinically diagnosed with lacrimal canaliculitis during 2011 and 2016 at Beijing Tongren Hospital of Capital Medical University have been analyzed. The enumeration data have been tested with Chi-square method. Results: The positive rate of bacterial culture was 78.8%, and the fungal culture tests of all cases showed negative results. Sixty strains of bacteria were isolated from 41 patients whose bacterial culture tests showed positive results, Gram-positive bacteria have been confirmed as the main among the isolated bacteria with Streptococcus (18.3%), Propionibacterium (18.3%), and Streptococcus (15.0%) identified as the three common genera. Thirteen cases (25.0%, all the 13 patients were female) involved with mixed infection, 13.3% (8/60) of the isolated strains were multi-drug resistant bacteria. The drug sensitive rate of the bacteria to fluoroquinolones antibiotics(79.3%, 230/290) was higher than that to cephalosporins(62.1%, 36/58) and aminoglycoside antibiotics(56.3%, 98/174), and such differences are of statistical significance (χ(2)=7.977, 27.738, P<0.05). Except for the fact that gram-positive bacteria are mostly sensitive to vancomycin, the sensitive rate of the bacteria to gatifloxacin was the highest and that to tobramycin was the lowest. Conclusion: Lacrimal canaliculitis tend to affect women and elderly patients. Staphylococcus, Propionibacterium, and Streptococcus are the three most common genera. Gatifloxacin may be the preferred antibiotic. Antibiotics combination therapy should be applied for multi-drug resistant bacteria. (Chin J Ophthalmol, 2018, 54: 111-114).

[Survey of HIV-1 drug resistance threshold in Shandong Province in 2013-2015]

Objective: To survey the prevalence of drug resistant HIV-1 in Shandong province in 2013-2015. Methods: WHO truncated sequential sampling technique was adopted by using 77 and 53 samples of newly diagnosed as HIV-1 positive and aged 16-25 years in Shandong province in 2013 and 2015. RNA was prepared and HIV-1 pol region was amplified by RT-PCR and nested PCR. Pol genetic mutation associated with drug resistance was analyzed. Results: The success rates for sequence acquisition of the survey were 100% (77/77) and 94% (50/53) in 2013 and 2015, and the main subtype was CRF01_AE. A total of 2 surveillance drug-resistance mutation(SDRMs) and 3 SDRMs were found by analyzing the 47 sequences each year, sampled in 2013 and 2015, indicating that the prevalence of drug resistant HIV-1 stains was low in 2013, and moderate in 2015. A total of 5 individuals with drug resistant HIV-1 stains found in this study were mainly infected by homosexual transmission (3 cases), and the other two samples were different: one was infected by heterosexual transmission, the other was infected by IDU. The subtype was CRF01_AE (2 cases) , CRF07_BC (2 cases) and B (1 case) . SDRMs for protease inhibitor (PIs), nucleotide HIV-reverse transcriptase inhibitor (NRTIs) and non-NRTI (NNRTIs) were all found in the individuals with drug resistant HIV-1 stains. Conclusion: CRF01_AE were the main HIV-1 subtypes of recently reported HIV-infected individuals in Shandong province, and the HIV-1 drug resistant strains transmission was catalogued as at low and moderate prevalence level in 2013 and 2015.

[Clinical study on the corneal epithelial dysfunction after cataract extraction]

Objective: To study the clinical manifestations, diagnosis and treatment of corneal epithelial dysfunction after cataract extraction. Methods: Fifteen cases diagnosed as corneal epithelial dysfunction after cataract extraction between November 2014 and September 2016 were retrospectively analyzed, mainly including clinical manifestations, characteristics of morphological changes imaged by in vivo laser confocal microscopy, management and therapeutic effects. Results: There were 6 (40%) males and 9 (60%) females with an average age of 66±7 years (59 to 86 years). Three patients had meibomian gland dysfunction. The clinical manifestations of corneal epithelial dysfunction after cataract extraction were corneal epithelial permeability increase, limitations of epithelial edema, corneal epithelial dot staining, corneal epithelial defects and ulceration. In vivo laser confocal microscopy showed enhanced reflection of the nucleus of the corneal basal cells, abnormal cell structure and decreased cell density. The morphology of corneal sub-basal nerve plexus was disordered and diminutive. After the therapy of protecting corneal epithelium and promoting healing, all 15 cases were cured completely. Conclusions: The early characteristics of cataract extraction-related corneal epithelial dysfunction are edema of the corneal epithelium and dot staining. Delayed diagnosis and treatment may result in filamentous keratitis and corneal ulcers. Timely use of corneal epithelium protection medicine may contribute to a favorable prognosis. (Chin J Ophthalmol, 2017, 53:188-192).

[Research progress of corneal epithelial basal cells and basement membrane]

The cylinder cells at the bottom of corneal epithelial cells are basal cells. Their cytoplasm contains keratin intermediate filament which is important in secretion of basement membrane. Corneal epithelial dysfunction due to diabetes or ocular surgery is intimately related with basal cell abnormality. Corneal epithelial basement membrane is a highly specific extracellular matrix which is made up of lamina lucida and lamina densa. It plays an extremely important role in renewal and restoration. Many ocular abnormalities and diseases have been described to relate to the corneal epithelial basement membrane, such as traumatic recurrent corneal erosion, corneal dystrophy and keratoconus. (Chin J Ophthalmol, 2016, 52: 703-707).

[Progress of study on the demodex blepharitis]

Demodex blepharitis is an infectious ocular disease which is common, but always to be neglected. There were a few related reports about this disease in China. The pathogenic mechanism of demodex blepharitis is not clear at present. Literatures held different ideas about its diagnosis, therapeutic methods and curative effect. This review will summarize the new development of demodex blepharitis in order to provide references for its basic and clinical researches.(Chin J Ophthalmol, 2016, 52: 315-320).

[Clinical analysis of 30 cases of children blepharitis]

OBJECTIVE

To study the clinical features and treatment of children blepharitis.

METHODS

Retrospective case series.

PARTICIPANTS

30 children patients less than 15 years old with blepharitis.

RESULTS

The clinical features , past diagnosis, treatment and therapeutic effect of 30 cases of children blepharitis recorded between Janurary 2010 to June 2013 were analyzed.

RESULTS

Of all the patients, 9 were male, and 21 were female. 15 cases (50%) were diagnosed as keratitis, among which 13 cases (43.3%) were diagnosed as virus keratitis. The main complications were keratopathy, accounting for 80%. Of all the 30 children blepharitis cases, 5 (16.7%) cases were cured; 21 (70%) cases got better; 2 cases (6.7%) recurred. Of 24 keratopaty associated with blepharitis cases, 17 cases (70.8%) were cured; 5 (20.8%) cases got better; 2 (8.3%) cases recurred.

CONCLUSIONS

Blepharitis is the common ocular surface disease, clinicians often ignore the eyelid to misdiagnosis.Children blepharitis usually affects cornea and results in keratopathy associated with blepharitis. Cure rate of Chlidren blepharitis is low. It becauses cure not only needs drug therapy but also demands patients adjust their habits and high obedience with doctors. (Chin J Ophthalmol, 2015, 51: 291-294).

[Clinical manifestations of 172 patients with blepharokeratoconjunctivitis]

OBJECTIVE

To summarize the clinical characteristics, diagnosis, and treatment of blepharokeratoconjunctivitis (BKC).

METHODS

Retrospective analysis. One hundred and seventy-two patients were diagnosed as BKC between January 2012 and December 2014 at Beijing Tongren Hospital. The clinical characteristics, the degrees of blepharitis and BKC, and the therapeutic effect were evaluated.

RESULTS

The patients were aged from 2 to 78 years (mean, 27±18 years). Forty-nine patients (28.5%) were males, and 123 patients (71.5%) were females. One hundred and five patients had photograph records of lid margin, cornea, and conjunctiva. BKC was unilateral in 28 (26.7%) of them, and bilateral in 68 (64.8%) with similar degrees and in 9 (8.6%) with different degrees. The disease was mild in 39 patients (40.6%), moderate in 24 patients (25.0%), and severe in 33 patients (34.4%). There was no significant difference in the degree of BKC between males and females (χ(2)=1.022, P=0.600). A total of 1 875 patients were diagnosed as blepharitis during the same period, and 172 patients (9.2%) were complicated by BKC. Female patients with blepharitis were more susceptible to BKC (χ(2)=8.355, P<0.05). Among the children patients with blepharitis, the incidence of BKC was significantly higher than that in the other groups (χ(2)=224.566, P< 0.05), but in the degree of BKC, there was no significant difference among groups. Typical clinical findings consisted of punctuate epithelial and subepithelial haze, stromal infiltrates, corneal ulcer, corneal scar, and corneal pannus. The patients were followed up for 1 to 80 months (mean, 7 months). According to the different degrees of BKC, the patients were given treatment for 1 month. Sixty-nine patients (71.9%) had clinical recovery, and the other cases were improved obviously. Nine patients (15 eyes) had recurred BKC during the follow-up period, and the recurrence rate was 9.2%.

CONCLUSIONS

BKC is not uncommon in patients suffering blepharitis, with a variety of clinical characteristics. Female and children patients with blepharitis are more susceptible to BKC. It is vital to perform standardized diagnosis and treatment for improvement of therapeutic effect.

Clinical value of concurrent radiochemotherapy in cervical cancer and comparison of ultrasonography findings before and after radiochemotherapy

Herein, we investigated the clinical value of concurrent radiochemotherapy for patients with advanced cervical cancer and its effects on adverse clinical symptoms. Forty patients with cervical cancer were recruited from January 2011 to January 2014 for this study. Participants were randomly allocated into a test or control group, with 20 patients in each group. Patients in the test group were treated with concurrent radiochemotherapy, whereas patients in the control group received only traditional radiotherapy. At the end of the observation period, clinical efficacy in the two groups was compared. Patients were followed up for 2 years, and the rates of recurrence, survival, and complications were compared; ultrasonographic findings before and after radiotherapy were also correlated. Patients in the test group who received concurrent radiochemotherapy showed significantly higher clinical efficacy than the control group at the end of treatment cycles. After 2 years of follow-up, the rates of recurrence, mortality, and complications were all significantly lower in the test group than in the control group (P < 0.05). Comparison of ultrasonographic findings before and after radiochemotherapy showed that the size of the tumor was significantly smaller in patients after concurrent radiochemotherapy. Compared with traditional radiotherapy, concurrent radiochemotherapy significantly improved clinical outcomes in patients with advanced cervical cancer. Concurrent radiochemotherapy also enhanced the rate of survival and decreased the rate of relapse, with enhanced clinical safety and no significant side effects. Thus, concurrent radiochemotherapy can be more broadly applied in the treatment of advanced cervical cancer.

Effect of MPO/H2O2/NO(-) system on nitric oxide-mediated modification of TTR amyloid and serum TTR in FAP ATTR Val30Met patients

Amyloid deposits consist of protein fibrils and amorphous material, and this deposition is related to oxidative stress. Previously, we demonstrated the presence of high-density lipoproteins and/or lipids in amyloid deposits of familial amyloid polyneuropathy patients. In this study, the presence of myeloperoxidase (MPO) in amyloid deposits was demonstrated using immunohistochemical staining. In contrast, normal surrounding tissues were consistently negative for MPO. Nitrotyrosine was present in amyloid deposits after being exposed to the MPO/H2O2/NO(-) system by immunohistochemical staining, and the oxide mediated modification of serum transthyretin (TTR) was observed upon exposure to the MPO/H2O2 system using two-dimensional gel electrophoresis and TTR Western blotting. This observation revealed that the TTR amyloid deposits and serum TTR were oxidized by the MPO/H2O2/NO(-) system. Nitric oxide-mediated modification of TTR may play a role in amyloidogenesis in vivo.

Seroprevalence of hepatitis C, hepatitis B virus and syphilis in HIV-1 infected patients in Shandong, China

To determine the seroprevalence of hepatitis C virus (HCV), hepatitis B virus (HBV) and syphilis in HIV-1-infected patients and related risk factors in Shandong province, China, we tested all eligible participants between 2000 and 2010 for the presence of anti-HCV antibody, hepatitis B surface antigen (HBsAg) and non-treponemal antibodies for syphilis after informed consent. Among 2087 HIV-infected patients, anti-HCV antibody was present in 41.2%, HBsAg in 12.6% and rapid plasma reagin (RPR) reactivity in 19.6%. In the multivariate logistic regression model, male gender (adjusted odds ratio [aOR] = 1.41), minority ethnicity (aOR = 1.72), syphilis infection (aOR = 1.40), former paid blood donors (aOR = 3.36), blood transfusion recipients (aOR = 2.91) and injection drug users (aOR = 1.98) were significantly associated with HCV infection. HCV infection (aOR = 1.40) and being men who have sex with men (aOR = 2.38) were significantly associated with syphilis infection. Co-infection with HCV, HBV and syphilis was observed frequently in all described subgroups of HIV infection. The results of this study suggest that it is necessary to screen for these viruses and syphilis in all Chinese HIV-infected patients.

A pilot study evaluating predictors of postoperative outcomes after major abdominal surgery: Physiological capacity compared with the ASA physical status classification system

Background

This pilot study compared the risk predictive value of preoperative physiological capacity (PC: defined by gas exchange measured during cardiopulmonary exercise testing) with the ASA physical status classification in the same patients (n=32) undergoing major abdominal cancer surgery.

Methods

Uni- and multivariate logistic regression models were fitted to measurements of PC and ASA rank data determining their predictive value for postoperative morbidity. Receiver operating characteristic (ROC) curves were used to discriminate between the predictive abilities, exploring trade-offs between sensitivity and specificity.

Results

Individual statistically significant predictors of postoperative morbidity included the ASA rank [P=0.038, area under the curve (AUC)=0.688, sensitivity=0.630, specificity=0.750] and three newly identified measures of PC: PAT (% predicted anaerobic threshold achieved, <75% vs ≥75%), ΔHR1 (heart rate response from rest to the anaerobic threshold), and HR3 (heart rate at the anaerobic threshold). A two-variable model of PC measurements (ΔHR1+PAT) was also shown to be statistically significant in the prediction of postoperative morbidity (P=0.023, AUC=0.826, sensitivity=0.813, specificity=0.688).

Conclusions

Three newly identified PC measures and the ASA rank were significantly associated with postoperative morbidity; none showed a statistically greater association compared with the others. PC appeared to improve predictive sensitivity. The potential for new unidentified measures of PC to predict postoperative outcomes remains unexplored.

Pharmacokinetics of terbinafine in the rabbit ocular tissues after topical administration

OBJECTIVE

To determine the distribution of terbinafine in the cornea and aqueous humor after topical administration.

METHODS

A corn oil ointment of terbinafine 0.2% (resolved in sterile corn oil) was applied to the conjunctival sac of albino rabbits twice (with a 5-min interval). The concentration of terbinafine was determined with high-performance liquid chromatography (HPLC) 5, 15, 30, 60, 120 and 240 min after administration of terbinafine.

RESULTS

After topical administration, the concentration of terbinafine increased gradually, reached a peak (1.39 microg/ml at 30 min in the cornea and 82.9 ng/ml at 30 min in aqueous humor, respectively) and then decreased. The concentration was 0.18 microg/g at 240 min in the cornea, but terbinafine could not be tested at 120 min in aqueous humor.

CONCLUSIONS

Topical ophthalmic terbinafine 0.2% could penetrate into the cornea and aqueous humor at concentrations adequate for inhibition of fungus.

[Effect of dingxin recipe on intracellular free calcium, membrane potential and mitochondria membrane potential in normal and hypoxia myocytes of rats]

OBJECTIVE

To elucidate the molecular mechanism on anti-arrhythmic function of Dingxin Recipe (DXR).

METHODS

Cardial myocytes isolated by trypsin method were cultured and labelled with various fluorescence stains. DXR contained serum induced changes of cytolic calcium concentration [Ca2+]i, cell membrane potential (MP) and mitochondria membrane potential (MMP) were determined with laser confocal microscopy.

RESULTS

Hypoxia caused increase of [Ca2+]i and MMP, and decrease of MP, while DXR contained serum lowered the [Ca2+]i in normal or hypoxian myocytes, improved hypoxia induced MP reduction and maintain MMP at baseline level under hypoxia circumstances.

CONCLUSION

Through inhibiting the hypoxia caused [Ca2+]i and MMP elevation and MP lowering, DXR displays its action in protecting myocardial cells to prevent and treat arrhythmia.

Differential expression of adenylyl cyclases in the rat nephron

BACKGROUND

Adenylyl cyclases (ACs) are a family of enzymes that catalyze the formation of the second-messenger cyclic adenosine 3',5'-monophosphate (cAMP). At least nine isoforms of AC have been cloned. These isoforms differ in their tissue distribution and basal activity. AC isoforms also differ in their capacity to be stimulated or inhibited by G protein alpha(i), alpha(s) and beta/gamma subunits, protein kinase C, and intracellular calcium. The distribution of ACs in the kidney is only partially known, although it is known that ACs play important roles in kidney signal transduction. Several receptors are known to couple to AC, but their linkage to individual AC isoforms in the kidney is not known.

METHODS

This study investigated the tissue distribution of AC isoforms along the nephron of Wistar-Kyoto rats using reverse transcription-polymerase chain reaction (RT-PCR), immunohistochemistry, and immunoblotting.

RESULTS

While AC VI and IX mRNA were found in all nephron segments, there was no expression of AC VIII mRNA. ACs II through V and VII mRNA were variably found in specific nephron segments. mRNA for AC isoforms II, III, VI, VII, and IX were expressed in renal proximal tubules. All of the AC isoforms studied, except VIII, were found in glomeruli. Immunoblotting and immunohistochemistry confirmed the mRNA results. AC isoforms II, III, IV, and IX were expressed in luminal rather than in basolateral membranes. However, immunohistochemical studies were not feasible for the other isoforms that could be expressed in basolateral membranes.

CONCLUSION

Knowledge of the distribution of ACs may help establish the linkage between receptors and specific AC isoforms and define their functions.

Exercise pathophysiology in patients with primary pulmonary hypertension

BACKGROUND

Patients with primary pulmonary hypertension (PPH) have a pulmonary vasculopathy that leads to exercise intolerance due to dyspnea and fatigue. To better understand the basis of the exercise limitation in patients with PPH, cardiopulmonary exercise testing (CPET) with gas exchange measurements, New York Heart Association (NYHA) symptom class, and resting pulmonary hemodynamics were studied.

METHODS AND RESULTS

We retrospectively evaluated 53 PPH patients who had right heart catheterization and cycle ergometer CPET studies to maximum tolerance as part of their clinical workups. No adverse events occurred during CPET. Reductions in peak O(2) uptake (VO(2)), anaerobic threshold, peak O(2) pulse, rate of increase in VO(2), and ventilatory efficiency were consistently found. NYHA class correlated well with the above parameters of aerobic function and ventilatory efficiency but less well with resting pulmonary hemodynamics.

CONCLUSIONS

Patients with PPH can safely undergo noninvasive cycle ergometer CPET to their maximal tolerance. The CPET abnormalities were consistent and characteristic and correlated well with NYHA class.

Carbon dioxide pressure-concentration relationship in arterial and mixed venous blood during exercise

To calculate cardiac output by the indirect Fick principle, CO(2) concentrations (CCO(2)) of mixed venous (Cv(CO(2))) and arterial blood are commonly estimated from PCO(2), based on the assumption that the CO(2) pressure-concentration relationship (PCO(2)-CCO(2)) is influenced more by changes in Hb concentration and blood oxyhemoglobin saturation than by changes in pH. The purpose of the study was to measure and assess the relative importance of these variables, both in arterial and mixed venous blood, during rest and increasing levels of exercise to maximum (Max) in five healthy men. Although the mean mixed venous PCO(2) rose from 47 Torr at rest to 59 Torr at the lactic acidosis threshold (LAT) and further to 78 Torr at Max, the Cv(CO(2)) rose from 22.8 mM at rest to 25.5 mM at LAT but then fell to 23.9 mM at Max. Meanwhile, the mixed venous pH fell from 7.36 at rest to 7.30 at LAT and to 7.13 at Max. Thus, as work rate increases above the LAT, changes in pH, reflecting changes in buffer base, account for the major changes in the PCO(2)-CCO(2) relationship, causing Cv(CO(2)) to decrease, despite increasing mixed venous PCO(2). Furthermore, whereas the increase in the arteriovenous CCO(2) difference of 2.2 mM below LAT is mainly due to the increase in Cv(CO(2)), the further increase in the arteriovenous CCO(2) difference of 4.6 mM above LAT is due to a striking fall in arterial CCO(2) from 21.4 to 15.2 mM. We conclude that changes in buffer base and pH dominate the PCO(2)-CCO(2) relationship during exercise, with changes in Hb and blood oxyhemoglobin saturation exerting much less influence.

Coronary artery stenoses: a phantom study using contrast enhanced three-dimensional electron beam tomography

This paper evaluated the accuracy of electron beam tomographic angiography (EBA) with conventional coronary arteriography (CCA) using four graded artificial stenoses in a postmortem swine coronary phantom model. The sensitivity, specificity, and accuracy of EBA for diagnosing significant stenosis (> or =50% stenosis) were 94.3%, 96.7%, and 95.8%, respectively. The diagnostic accuracy of EBA had no significant difference with CCA (chi(2)=0.0162; P>.05). EBA three-dimensional (3D) procedures had high interobserver reproducibility (k=.92-.95, P>.05). Maximum intensity projection (MIP) was the most sensitive and curved planar reformation (CPR) was the most accurate 3D procedure for quantitatively identifying coronary stenosis. EBA yields promising results concerning the visualization of coronary artery stenosis with high accuracy for stenoses >50%.

A noninvasive assessment of pulmonary perfusion abnormality in patients with primary pulmonary hypertension

STUDY OBJECTIVES

The ventilatory equivalent for CO(2) (ie, the ratio of minute ventilation [VE] to carbon dioxide output [VCO(2)]) is increased in patients with primary pulmonary hypertension (PPH) consequent to an increase in physiologic dead space and alveolar ventilation. We wished to see whether the VE/V(2) ratio correlated with the abnormality in pulmonary hemodynamics in PPH patients and whether it changed in response to prostacyclin infusion.

METHODS

Following right-sided heart catheterization, 10 patients with severe PPH were studied in the coronary-care unit while hemodynamic and gas exchange measurements were measured simultaneously before and after infusion with epoprostenol (Epo), a prostacyclin analog. Studies were performed at baseline and during IV infusion of two to three increasing dosages of Epo in 10 PPH patients (NYHA class III-IV). Four patients had radial artery catheters for simultaneous blood gas measurements. Nine healthy subjects who were matched by sex, height, and weight underwent gas exchange analyses only.

RESULTS

The mean (+/- SD) VE/VCO(2) ratio was higher in PPH patients than in control subjects (50.7 +/- 9.7 vs 30.6 +/- 3.8; p < 0.001). Thirteen measurements made in four patients showed that the VE/VCO(2) ratio correlated with the physiologic dead space/tidal volume ratio (r = 0.78; p = 0.002). The VE/VCO(2) ratio measurement at baseline correlated significantly with total pulmonary vascular resistance (TPVR) (r = 0.70; p = 0.02) but not with mean pulmonary artery pressure (mPAP) or cardiac index. During Epo infusion, the VE/VCO(2) ratio decreased with increasing dosage in 6 of 10 patients, with no change or slight increases in the 4 remaining patients. Considering all doses, the VE/VCO(2) ratio decreased significantly in response to the short-term administration of Epo. The decrease tended to parallel the pattern of decrease in TPVR, but the changes in both variables were too small to provide a statistically significant correlation. The mPAP did not change significantly in response to Epo infusion, although TPVR did change at the highest dosage.

CONCLUSIONS

In patients with severe PPH, the VE/VCO(2) ratio correlated significantly with TPVR but not with mPAP or cardiac index. The VE/VCO(2) ratio decreased systematically from baseline with the dose of Epo in some but not all patients. The VE/VCO(2) ratio and TPVR decreased significantly in response to Epo when all doses were considered. Further studies are needed to elucidate whether noninvasive gas exchange measurements may be clinically useful in the evaluation of the severity of pulmonary vascular disease and the effectiveness of pulmonary vasodilator therapy.

Comparison of exercise cardiac output by the Fick principle using oxygen and carbon dioxide

BACKGROUND AND STUDY OBJECTIVE

Theoretically, cardiac output (CO) calculated by the Fick principle should be the same using O(2) (CO[O2]) or CO2 (CO[CO2]) as the test gas. However, agreement depends on the accuracy of gas exchange and blood gas measurements and the validity of the equations to convert measured variables into blood gas contents. Considering the widespread use of indirect estimates of pulmonary artery blood PCO2 and CO2 content to measure Fick principle CO during exercise, we wished to determine whether CO[O2] and CO[CO2] were equal during exercise and whether CO[CO2] could be accurately and precisely determined using direct measures of pulmonary artery blood. PREPARATION AND METHODS: Five healthy young nonsmoking volunteer men performed incremental exercise from rest to peak exercise on two separate occasions with intervening rest. Catheters were placed in brachial and pulmonary arteries to allow repeated blood sampling every minute during concurrent breath-by-breath gas exchange measurements from rest to peak exercise. CO[O2] was compared with CO[CO2] at multiple levels of exercise. Using standard equations, arterial and mixed venous O2 contents were calculated from hemoglobin concentration (Hb), oxyhemoglobin saturation (SO2), and PO2, whereas CO2 contents were calculated from PCO2, pH, Hb, and SO2. Blood gas analyzers were used for measurement of pH, PCO2, and PO2, and a co-oximeter was used for measurement of Hb and SO2. Initial calculations suggested that exercise CO[CO2] was 14% higher than CO[O2] and helped disclose small systematic measurement errors in PCO(2) for values > 45 mm Hg detected by proficiency testing surveys and documented with blood tonometry in the blood gas analyzer.

RESULTS

After correcting PCO2 for the small systematic measurement error found, the measures and equations used to calculate arterial and mixed venous O2 and CO2 contents were adequate to provide mean CO values that are reasonably similar. However CO[CO2] values were more than twice as variable as CO[O2].

CONCLUSIONS

The increased variability of Fick principle CO[CO2] compared with CO[O2] is attributable to the much lower extraction ratio for CO2 and the greater complexity in calculation of blood CO2 than O2 contents. These results raise concerns about the accuracy and precision of estimating CO and stroke volume using CO2 as a test gas, even with direct measurement of blood CO2 contents in normal subjects.

Aerobically generated CO(2) stored during early exercise

Previous studies have shown that a metabolic alkalosis develops in the muscle during early exercise. This has been linked to phosphocreatine hydrolysis. Over a similar time frame, the femoral vein blood pH and plasma K(+) and HCO(-)(3) concentrations increase without an increase in PCO(2). Thus CO(2) from aerobic metabolism is converted to HCO(-)(3) rather than being eliminated by the lungs. The purpose of this study was to quantify the increase in early CO(2) stores and the component due to the exercise-induced metabolic alkalosis (E-I Alk). To avoid masking the increase in CO(2) stores by CO(2) released as HCO(-)(3) buffers lactic acid, the transient increase in CO(2) stores was measured only for work rates (WRs) below the lactic acidosis threshold (LAT). The increase in CO(2) stores was evident at the airway starting at approximately 15 s; the increase reached a peak at approximately 60 s and was complete by approximately 3 min of exercise. The increase in CO(2) stores was greater, but the kinetics were unaffected at the higher WR. Three components of the change in aerobically generated CO(2) stores were considered relevant: the carbamate component of the Haldane effect, the increase in CO(2) stores due to increase in tissue PCO(2), and the E-I Alk. The Haldane effect was calculated to be approximately 5%. Physically dissolved CO(2) in the tissues was approximately 30% of the store increase. The remaining E-I Alk CO(2) stores averaged 61 and 68% for 60 and 80% LAT WRs, respectively. The kinetics of O(2) uptake correlated with the time course of the increase in CO(2) stores; the size of the O(2) deficit correlated with the size of the E-I Alk component of the CO(2) stores. We conclude that a major component of the aerobically generated increase in CO(2) stores is the new HCO(-)(3) generated as phosphocreatine is converted to creatine.

Overexpression of protein kinase Calpha in MCF-10A human breast cells engenders dramatic alterations in morphology, proliferation, and motility

A nonmetastatic human mammary epithelial cell line (MCF-10A) was engineered to overproduce protein kinase Calpha (PKCalpha) so as to investigate a role for this isoform in the metastatic phenotype. PKCalpha transfectants (clone 26alpha) expressed an 8-fold higher level of PKCalpha protein without compensatory alterations in other isoforms. Clone 26alpha proliferated slowly (accumulating in G1 of the cell cycle) but exhibited pronounced increases in motility and adhesion. Elevated expression of cell cycle inhibitor p27 and focal adhesion proteins was observed, whereas E-cadherin expression decreased to undetectable levels. These observations were consistent with the morphology of PKCalpha transfectants (large, disaggregated, and flat, with lamellipodia and extensive actin fibers) and control cells (small, aggregated, and refractile). Treatment with PKC inhibitors or transfection of a dominant negative (dn) mutant of Rac1, but neither dn RhoA nor dn cdc42, reduced the motility of clone 26alpha, implicating PKCalpha catalytic activity and endogenous Rac1, respectively, in the PKCalpha-induced phenotype. Overall, PKCalpha overexpression suppresses proliferation while endowing MCF-10A cells with properties consistent with the metastatic phenotype.

Spectroscopic comparison of different DNA structures formed by oligonucleotides

Six different nucleic acid structures including duplex, triplex and quadruplex are formed by oligonucleotides. Their structural properties are studied in detail by four spectroscopic techniques, i.e. CD, UV, NMR and fluorescence. Results are: CD Spectra: The common characteristics is a negative band at 240 nm, and the spectra are different from each other in the range 260-300 nm. Many factors such as chain direction, sugar puckering, orientation of the glycosyl bond, base stacking and sequence can effect their conformation and then show diversity and complexity in the spectra. UV Spectra: The UV spectra of all forms are quite similar, all of them exhibit a sharp positive peak around 210 nm and a broad positive band in the region of 240-280 nm. Although the bands are different in absorbance, the spectra are not characteristic enough to distinguish these forms. In addition, their thermal denaturation is also observed by UV spectrum, different melting curves and points are shown and some thermodynamic information is provided. NMR Spectra: Since the G residues in the six samples all participate in hydrogen bond, the imino proton can not exchange with the solvent freely so as to allow an observable resonance to arise. The resonance number and chemical shift will vary with the change in base-pairing number and mode as well as the whole geometry of its molecule. Fluorescence Spectra: The interaction mechanisms between EB and these structures are different. B type duplex and triplex adopt an intercalative mode in which the efficiency of energy transfer is relatively high and the fluorescence of EB can not be quenched easily. While for the parallel duplex, outside binding is predominant in which energy transfer can hardly happen and most of its fluorescence can be quenched. As for the quadruplex, groove binding is possible, so the efficiency of energy transfer is higher than that in outside binding, but lower than that in intercalative binding, and fluorescence is quenched partly.

Deletion analysis of protein kinase Calpha reveals a novel regulatory segment

Using a combined pharmacological and genetic approach, we have identified aa 260-280 in the C2 region as a critical factor in the catalytic function of protein kinase Calpha (PKCalpha). Progressive truncations from the N-terminus as well as selected internal deletion mutants were expressed in Saccharomyces cerevisiae and tested for altered sensitivity to dequalinium, a PKC inhibitor whose target site was previously mapped to the catalytic domain. PKC mutants representing truncations of up to 158 amino acid residues (aa) from the N-terminus (ND84 and ND158) displayed 60-63% inhibition of kinase activity by 50 microM dequalinium, somewhat more sensitive than the wild-type PKCalpha enzyme (45% inhibition). Mutant ND262, lacking N-terminal aa 1-262, was inhibited by almost 72% with 50 microM dequalinium, but mutant ND278, which lacked an additional 16 aa, was inhibited by only 9% of total activity. This result suggests that a C-terminal segment of the C2 region (aa 263-278) influences inhibition by dequalinium at low micromolar concentrations. An internal deletion mutant (D260-280) which retains the entire primary structure of PKCalpha except for aa 260-280, was similarly inhibited by only 4% with 50 microM dequalinium. In the absence of dequalinium and despite the presence of a nearly complete regulatory domain, this mutant exhibited constitutive activity (both in vitro and in a phenotypic assay with S. cerevisiae) that could not be further stimulated even by the potent activator TPA. Taken together, our findings suggest that, in the native structure of PKCalpha, the segment described by aa 260-280 regulates PKCalpha activity and influences the sensitivity of PKCalpha to dequalinium.

Photoinduced inactivation of protein kinase C by dequalinium identifies the RACK-1-binding domain as a recognition site

1,1'-Decamethylenebis-4-aminoquinaldinium diiodide (DECA; dequalinium) is an anti-tumor agent and protein kinase C (PKC) inhibitor whose mechanism of action with PKC is unknown. This study reports that with human PKC alpha, DECA exhibited competitive inhibition (Ki = 11.5 +/- 5 microM) with respect to RACK-1 (receptor for activated C kinase-1), an adaptor protein that has been proposed to bind activated PKC following translocation (Ron, D., Luo, J., and Mochly-Rosen, D. (1995) J. Biol. Chem. 270, 24180-24187). When exposed to UV light, DECA covalently modified and irreversibly inhibited PKC (alpha or beta), with IC50 = 7-18 microM. UV/DECA treatment of synthetic peptides modeled after the RACK-1-binding site in the C2 region of PKC beta induced modification of Ser218-Leu-Asn-Pro-Glu-Trp-Asn-Glu-Thr226, but not of a control peptide. This modification occurred at a tryptophan residue (Trp223) that is conserved in all conventional PKC isoforms. In overlay assays with native RACK-1 that had been immobilized on nitrocellulose, UV-treated control PKC alpha bound well to RACK-1, whereas UV/DECA-inactivated PKC alpha had reduced binding activity. The significance of these findings is shown with adenocarcinoma cells, which, when pretreated with 10 microM DECA and UV light, exhibited diminished 12-O-tetradecanoylphorbol-13-acetate-induced PKC alpha translocation. Overall, this work identifies DECA as a tool that prevents PKC translocation by inhibiting formation of the PKC.RACK-1 complex.

Formation and characteristics of an unusual lambda-DNA species

An unusual DNA species, termed as DNA species A, has been isolated and purified from thermal-denatured lambda-DNA Hind III by Sephadex G-200 gel filtration. Our studies indicate that DNA species A is resistant to DNase I digestion and has a higher melting point. The new DNA species showed a lower absorbency at 260 nm, and a lower fluorescence quantum yield after interaction with ethidium bromide (EB) than native double-stranded lambda-DNA. CD spectrum of DNA species A consists of a broad positive band centered at 245 nm and a weak negative band at 220 nm. transmission electron microscope (TEM) visualizations showed that their lengths of DNA species A fell mainly in three regions (300-500 nm, 750-1000 nm and 1500 nm) that corresponded to three fluorescence bands in the EB-stained gels. Their apparent width and height were 65-75 nm and 2.2 nm respectively as observed by images of atomic force microscope (AFM).

The usefulness of technetium-99m-MIBI scintimammography in diagnosis of breast cancer: using surgical histopathologic diagnosis as the gold standard

The purpose of this study was to evaluate the usefulness of 99mTc-MIBI scintinammography for the detection of breast cancer.

METHODS

Sixty-one consecutive patients referred for a suspicions breast lesion on clinical examination were studied with 99mTc-MIBI scintimammography. There were 60 female patients and 1 male patient with 63 pulpable breast abnormalities. Each patient received 20mCi 99mTc-MIBI intravenously. Ten and 120 minutes postinjection, three planar views, right and left lateral prone and anterior supine thoracic views, were obtained. The patient underwent surgery within one week and the final diagnostic results (histopathology) were obtained.

RESULTS

Thirty-two of 63 abnormalities of breast were pathologically confirmed breast cancer, and 31 were benign lesions. In the group of patients studied, the sensitivity of 99mTc-MIBI scintimammography was 78.1% (25 true-positive, 7 false-negative) and the specificity was 90.3% (28 true-negative, 3 false positive). The positive predictive value was 89.3%, the negative predictive value was 80.0%, the positive likelihood ratio was 8.1, the negative likelihood ratio was 0.2.

CONCLUSION

This study showed the high diagnostic accuracy of 99mTc-MIBI scintimammography in detecting breast cancer. 99mTc-MIBI scintimammography can be used as an assistant method to non-invasively assess breast cancer invasiveness before surgery.

[Intrasplenic metastasis of malignant ovarian tumor: clinical analysis of 12 cases]

Intrasplenic metastasis of ovarian malignancies are uncommon. From 1986 to 1992 only 12 such cases were diagnosed, being 1.2% of the total number of patients with ovarian malignancies treated in tumor hospital during the same period. Of the 12 metastasis, 6 were poorly differentiated. Diagnosis was made through imaging techniques or surgery. The median interval from the diagnosis of the primary disease to intrasplenic involvement was 28 months. The metastatic lesions, presented themselves as single or multiple nodes within the cortex of the spleen. Clinical features were not remarkable. It was thought that the occurrence of intrasplenic involvement might be due to greater tumor bulk, poor differentiation and decreased host immuno-competence caused by chemotherapy. Most of the intrasplenic metastasis was found after liver metastasis or simultaneously with the latter. The main route of the tumor spread might be via blood vessels. Sole intrasplenic metastasis can be treated by surgery with a temporarily good result. Poor prognosis and high mortality characterize intrasplenic metastasis. The median survival was only 7 months.

[Determination of esculetin in semen Euphorbiae lathyridis L. by TLCS and comparison on the quality in different areas]

A TLC-densitometric method for the determination of oesculetin in Semen Euphorbia lathyridis (Euphorbiae lathyrdis) was established, and esculetin content in Semen Euphorbia lathyridis from three different producing areas (Zhengzhou, Chengdu and Chongqing) was determined. The method is accurate, sensitive and simple. The recovery is 98.63% and the coefficient of variation is 1.59% (n = 5). The esculetin average contents in the three samples are 0.3013%, 0.2046% and 0.2094% respectively.